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Secondary parkinsonism

Parkinsonism - secondary; Atypical Parkinson disease

 

Secondary parkinsonism is similar to Parkinson disease, but the symptoms are caused by certain medicines, a different nervous system disorder, or another illness.

Parkinsonism refers to any condition that involves the types of movement problems seen in Parkinson disease. These problems include tremors, slow movement, and stiffness of the arms and legs.

Causes

 

Secondary parkinsonism may be caused by health problems, including:

  • Brain injury
  • Diffuse Lewy body disease (a type of dementia)
  • Encephalitis
  • HIV/AIDS
  • Meningitis
  • Multiple system atrophy
  • Progressive supranuclear palsy
  • Stroke
  • Wilson disease

Other causes of secondary parkinsonism include:

  • Brain damage caused by anesthesia drugs (such as during surgery)
  • Carbon monoxide poisoning
  • Certain medicines used to treat mental disorders or nausea
  • Mercury poisoning and other chemical poisonings
  • Overdoses of narcotics
  • MPTP (a contaminant in some street drugs)

There have been rare cases of secondary parkinsonism among IV drug users who injected a substance called MPTP, which can be produced when making a form of heroin.

 

Symptoms

 

Common symptoms include:

  • Decrease in facial expressions
  • Difficulty starting and controlling movement
  • Loss or weakness of movement (paralysis)
  • Soft voice
  • Stiffness of the trunk, arms, or legs
  • Tremor

Confusion and memory loss may be likely in secondary parkinsonism. This is because many diseases that cause secondary parkinsonism also lead to dementia.

 

Exams and Tests

 

The health care provider will perform a physical exam and ask questions about the person's medical history and symptoms. Be aware that the symptoms may be hard to assess, particularly in the elderly.

Examination may show:

  • Difficulty starting or stopping voluntary movements
  • Tense muscles
  • Problems with posture
  • Slow, shuffling walk
  • Tremors (shaking)

Reflexes are usually normal.

Tests may be ordered to confirm or rule out other problems that can cause similar symptoms.

 

Treatment

 

If the condition is caused by a medicine, the provider may recommend changing or stopping the medicine.

Treating underlying conditions, such as stroke or infections, can reduce symptoms or prevent the condition from getting worse.

If symptoms make it hard to do everyday activities, the provider may recommend medicine. Medicines used to treat this condition can cause severe side effects. It is important to see the provider for check-ups. Secondary parkinsonism tends to be less responsive to medical therapy than Parkinson disease.

 

Outlook (Prognosis)

 

Unlike Parkinson disease, some types of secondary parkinsonism may stabilize or even improve if the underlying cause is treated. Brain problems, such as Lewy body disease, are not reversible.

 

Possible Complications

 

This condition may lead to these problems:

  • Difficulty doing daily activities
  • Difficulty swallowing (eating)
  • Disability (varying degrees)
  • Injuries from falls
  • Side effects of medicines used to treat the condition

Side effects from loss of strength (debilitation):

  • Breathing in food, fluid, or mucus (aspiration)   
  • Blood clot in a deep vein (deep vein thrombosis)
  • Malnutrition

 

When to Contact a Medical Professional

 

Call the provider if:

  • Symptoms of secondary parkinsonism develop, come back, or get worse
  • New symptoms appear, including confusion and movements that cannot be controlled
  • You are unable to care for the person at home after treatment starts

 

Prevention

 

Treating conditions that cause secondary parkinsonism may decrease the risk.

People taking medicines that can cause secondary parkinsonism should be carefully monitored by the provider to prevent the condition from developing.

 

 

References

Jankovic J. Movement disorders. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.

Lang AE. Parkinsonism. In: Goldman L, Schafer AI. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 409.

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          Review Date: 8/13/2015

          Reviewed By: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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